Provider Demographics
NPI:1225893316
Name:GILLIS, ROSARIA Z (LPCA)
Entity Type:Individual
Prefix:
First Name:ROSARIA
Middle Name:Z
Last Name:GILLIS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 COLLEGE ST UNIT 202
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2944
Mailing Address - Country:US
Mailing Address - Phone:803-879-7707
Mailing Address - Fax:
Practice Address - Street 1:7320 COLLEGE ST UNIT 202
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2944
Practice Address - Country:US
Practice Address - Phone:631-772-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD8858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health